Visceral Work

January 21, 2014

One question I hear from people who know that Rolfing® Structural Integration is hands-on bodywork but don't really know what it is: "Is Rolfing® Structural Integration a type of massage?"

One question I hear from clients who are massage therapists or craniosacral practitioners or newer Rolfers™: "Where did you learn that technique?"

These questions are actually interrelated and speak to something relatively unique about Rolfing work – and bodywork mastery in general: the difference between protocols and techniques, and the integration of skills into a sort of "mastery" (for lack of a better word) that can come from years in practice but requires a certain environment to develop.

Students in massage classes typically learn protocols: first do this for a few strokes, then do that for a few strokes, then move here and do this. Many craniosacral classes are the same, at least for the first few levels, teaching rote protocols to do on each client. This works as a learning tool for students, and it makes teaching easier for teachers. For larger classes, it's almost necessary as any other mode of teaching requires a higher teacher:student ratio.

With this kind of "technique" training, you often get competent practitioners. But they can be the kind of practitioner who can do a massage while also planning his shopping list in his head, because it is all rote. These practitioners may develop further, but many will not, as it's easy to just do the same thing over and over again, to have your set of "moves" that tend to get you certain results and that people tend to like. This is what alot of spa treatments are like, especially since the therapists are on tight schedules so it's often like a production line. (I know because I once worked at a "world-class" spa, but was appalled at what was often delivered.) That's not to say it will be bad work, but it's fixed because the nature of the business does not encourage innovation or deviation from a set standard.

Massage practitioners and craniosacral therapists in private practice may get more creative. Continuing education classes can help a practitioner develop in many ways, but sometimes these are places to just learn more techniques to add to your toolbox. These are the kinds of practitioners who ask me "Where did you learn that technique?" Continuing education classes to learn techniques are useful, but they don't take you out of the box. That requires a certain kind of thinking, and a certain "art" on the part of the practitioner.

Rolfing SI as a profession is somewhat unique in its training methodology. We learn a few techniques here and there, but our work really comes down to customization and frank innovation. Even with the "Ten Series" – the ten-session Rolfing series to optimize the body into a basic alignment, as illustrated by our "Little Boy Logo" – the sessions are not a protocol of defined moves but rather a progression of work governed by certain principles and customized to each client.

As I tell my Rolfing clients in Seattle, each session of the Series has a goal and a territory of the body, but to achieve that goal I need to make my own strategy based on what I see in that person's body. This is how we are taught at the Rolf Institute®, so we have to be seeing and analyzing bodies and thinking out of the box from the first days of our Rolfing training. This makes Rolfing training very intense and challenging, and some new Rolfers come out of school feeling overwhelmed and uncertain or even angry as there are not those handy techniques to rely on. It's an uncertain world, but one that Rolfers learn to swim in.

So if you come into my Seattle or Port Orchard office for a Rolfing session, what I do with you will not be rote. It will not be what I did with my last client, or what I did with you the last time I saw you, or even what I did that worked for someone else who came in with the same issue. And what I do may be brand new, something I've never done on anyone else before, something I invent based on what I have to figure out unique to your body. So a good Rolfer is always inventing "techniques" but never storing them away as fixed items to be pulled out of a metaphorical toolkit and applied indiscriminately.

This relates to this earlier post about "Rolfing is to massage as the Navy Seals are to the Boy Scouts", a quote that comes from a comment a Rolfing client made to his Rolfer. A Boy Scout learns a whole bunch of skills and has many useful tricks up his sleeve, but has not matured into a seasoned woodsman. The work of a Navy Seal requires different training and a higher-level arsenal of skills – plus the ability to strategize and think on his feet to get results.

It's the training we receive as Rolfers, and the way we go about thinking about our work, that makes us particularly good at sorting out what others may not get results with. For example, injuries do not respond well to protocols. So many clients come into my Seattle office saying, "I've tried chiropractic, physical therapy, massage, acupuncture... they've helped a little but it doesn't last," or "it knocked the pain back a bit but the problem is still there..." Obviously, when so many credentialed and talented folks have already had a go at this person's issue, I'm going to have to think out of the box, and as is said, "necessity is the mother of invention."

This has led me deeper into craniosacral and visceral work also. Sometimes clients tell me "the way you do craniosacral is different from others I've been to." That may be because as a Rolfer I'm more engaged with the cranial fascias than someone without a "fascial fascination" would be. But it may also be that they've seen other practitioners who have applied a protocol or fixed techniques, as that is how much cranial training is done (at least that outside the osteopathic world). As with Rolfing sessions, I will invent a cranial technique on the spot, if what I've learned elsewhere does not give me access to the right structures or vectors to ease a strain pattern. Now you cannot do this without a certain critical background in anatomy, highly developed palpation skills, and highly developed touch.

So it's not invention for the sake of invention, but invention because you need to determine exactly what is needed for the situation and you have the understanding of the body to do that. Each body event – whether an auto accident, a pain scenario, a postural pattern, etc. – has its unique history and configuration in the body. Unraveling these fully generally requires work from a bodyworker who has moved beyond technique and into the art of the profession, where the practitioner is capable of creating the work that your body needs.

December 31, 2013

One of my Seattle Rolfer™ colleagues shared this on a discussion forum we have for its relevance to the psoas muscle. In the Rolfing® Structural Integration world, we love (worship?) the psoas, which spans two joints. Broadly speaking, it's the "iliopsoas," with the "psoas" portion going from the femur to the lumbar spine and the "iliacus" going from the femur to the iliac crest of the hip. It's a hip flexor, and is the first muscle to engage as you flex your hip (raise your knee); it's also the muscle that stabilizes when you stand on one leg.

When it's spasmed, the back can go out. Ever heard a friend say his back is out and he can't put on his socks or pants? Well, to do that you have to flex your hip, so this points to the psoas being involved. A tight psoas can also cause many pelvic tilt issues or lumbar sidebends. And not surprisingly – because it travels along the colon and kidneys – there can be a visceral relationship here too.

A happy psoas? An integrated psoas? Watch the lead dancer in this video below and check out the lubrication of that pelvis and how lightly and easily he flexes his hips. All the dancers move well enough, but he stands out for the light quality of his movement.

Now Ida Rolf, the founder of Rolfing Structural Integration, was born in 1896, so her reference point was an earlier era. She always spoke of Fred Astaire as having the "perfect psoas." Watch this video and you'll see the same light quality, his legs just float under him, so that Gene Kelly seems relatively earthbound by comparison.

In working with my Seattle Rolfing clients, I very often do some psoas work – a little or alot! While it may seem paradoxical, the psoas can even play a role in neck and shoulder issues. Anatomically, it's in a different region, but if the psoas is tight and shortening the whole anterior of the body, it will be implicated in a forward-head posture and shoulder-girdle slump. It's a hip flexor, right? When you sit all day long at a desk, your psoas is in that flexed (shortened) posture all day, and lengthening becomes imperative for proper alignment and integration. How to stretch your psoas? – lunges (yogic or otherwise).

So whether it's back pain from an auto/work accident, a sports injury, or too much yardwork; poor posture; a tight pelvis; or a heavy, clunky quality to the legs, learning about your psoas and getting better psoas length and integration may help put you back in your dancing shoes!

August 30, 2011

What is behind sports injuries that won't quickly heal? Running Times Magazine published a great article on the rolf of fascia, and you can read it online here, including information on how Rolfing® Structural Integration can help with fascial injuries and problems.

The article starts with a great explanation of what fascia is, summed up in this quote from Rolfer™ Tom Myers: "While every anatomy [book] lists around 600 separate muscles, it is more accurate to say that there is one muscle poured into six hundred pockets of the fascial webbing." What this means is that any injury or stress to an individual muscle will affect the fascial webbing as a whole. Think of a snag in a knit fabric; it will be most gnarly in the area of the snag itself, but it will create a pull through the fabric that can distort the whole. Resolving the problem means fixing not only the area of the "snag" but also it's compensating patterns in other areas of the fascial net / body.

The article goes on to explain that new research shows that fascia is not just wrapping, but tissue that can "contract, feel, and impact the way you move" - meaning that it can be negatively impacted by lack of activity, chronic stress, poor posture, injuries, and repetitive movements. While this is new news to mainstream healthcare and media, Rolfers have known this for years, and in my Seattle Rolfing® practice I see many athletes with fascial issues that can be helped, as well as many non-athletes whose fascia has become tight or imbalanced from other activities - like hunching over a computer for hours a day, carrying young children around, auto accidents, and the like.

The article mentions Rolfing in a section on fascial care. The things you can do on your own to maintain healthy, flexible, resilient fascia include staying hydrated, streching, and not pushing through injuries. Outside help includes movement education and seeing a "fascial specialist." I think it's fair to say that Rolfers were the first fascial specialists, as Ida Rolf was one of the first people to 1) credit fascia with its proper role in the body and to 2) develop work to lengthen, sculpt, and balance the fascia. Many other practitioners will be trained to work with a local injury, but not necessarily know how to work with the pattern as it extends through your whole body. (I wrote about that here in a blog post about how Rolfers work with fascia differently than massage therapists, but the same thinking applies also to Rolfing versus physical therapy.)

If you are interested to learn more about fascia and how Rolfing could help you, feel free to call me if you are in the Seattle area for a phone or office consult, or visit the Rolf Institute® website for a list of Certified Rolfers and Certified Advanced Rolfers in your area. Like some other Rolfers, I also practice visceral work, craniosacral work, and nerve work. While these use a lighter end of the touch spectrum, they are also fascial-based modalities as fascial strain patterns are behind visceral strain, cranial strain, and tethered nerves.

All in all, Running Times Magazine has published a great article, well worth reading to understand more about your body and fascia in particular.

December 14, 2010

I very often see clients who complain of reduced range of motion (ROM) in the neck (cervical spine). Oftentimes, reduced neck ROM means neck pain as well, or headaches. I find that I can generally bring back good ROM using a combination of Rolfing® Structural Integration and craniosacral work. Sometimes visceral work is needed, or manual therapy for the nerves. Finding a body therapist trained in all of these modalities is your best bet, as they can address the problem whatever its source is.

What Causes Neck ROM Problems?

There are three key motions for the spine: forward- and backward-bending, side-bending, and rotation. Any of these can be reduced by

an auto accident (especially whiplash),

sleeping in an uncomfortable position,

a bad fall,

habitually having your head turned one way (eg., your computer monitor is to your right),

holding the phone to your ear with a shoulder,

a forward-head posture, or

tight muscles.

Think for a moment about a whiplash. Say you are rear-ended while stopped at a traffic signal and your head is turned right because you are saying something to your friend in the passenger seat. Not only are the muscles at the front and back of the neck stressed, because your head is turned, a side-to-side imbalance can also set in, making it more difficult to turn your head one way.

What Kind of Treatment Helps?

Chiropractic work is excellent in these cases, as there is sometimes a vertebrae "out," but the issue may not fully resolve without soft-tissue work like Rolfing sessions, as it's an imbalance in the muscle/fascial tension on the vertebrae that holds them out of place. (This is why people often need less chiropractic care after they do Rolfing sessions: the newly balanced soft tissue allows the vertebrae to hold adjustments better.)

More severe restrictions can involve the dural tube (the "stocking" of fascia that surrounds the spinal cord), which responds to craniosacral work. Sometimes the ligaments that suspend the pleura of the lungs are also involved, as they attach directly to the 7th cervical vertebra; in this case, I do visceral work as well.

I also encourage clients to consider acupuncture as it can be of great assistance. For ongoing maintenance, a yoga practice is excellent.

How Many Sessions Are Needed?

In minor cases, one session will usually fix a "kinked" neck. With a major injury, repeated sessions are often needed, but you should get some immediate relief from the first session and see incremental progress with each session. In Washington and many other states, auto insurance policies will pay for your care after an auto accident, as will worker's compensation in work injuries. I will bill these insurances directly, and so will many other Rolfers™.

With good treatment, you can recover neck ROM in most cases where the problem is musculoskeletal. Your neck will not be a flexible as the chicken in this video below (there's something unique to chicken anatomy), but it might feel this loose!

November 26, 2010

As I'm a Rolfer™, most of the clients coming into my Seattle bodywork practice are addressing posture or pain in some fashion – even if their bodies function pretty well, they want them to function better. This is a great goal, and Rolfing® Structural Integration in particular works to optimize the body's structure in a way that serves this goal. As do craniosacral work (for headaches, TMJ, whiplash, auto injury) and visceral work (implicit in many postural issues and often a "missing piece" when someone has a stubborn pain issue).

In my practice one of my goals is "mind-body integration," and with yesterday being Thanksgiving I reflected on how our attitudes towards our bodies can affect how easily we can recover from injury and change old patterns. This is not to say that pain is "all in your head." After all, an auto accident or other injury, or pain from a postural complaint, can definitely turn aspects of your life downhill. Rather, it's to say that viewing your body in an appreciative way, for all that it does for you, gives holding and context for change and optimization to occur, and compassion for the ways we are suffering.

For example, I'll never forget a client of mine who was dealing with alot of physical pain – from fibromyalgia, and from an acute knee injury. She also had emotional pain from a recent ugly divorce. One day during a session she said with vehemence "I hate my body." I don't know how that felt to her or to her body, but to me it felt like a slap, and I wasn't even the object of her hatred.

In wondering how her body felt in response to the hatred and rejection she expressed toward it, I remember an episode in Unit II of my training at the Rolf Institute® of Structural Integration. In this phase of the training, students work on each other to learn the Rolfing "Ten Series" of work. The training is intense, requiring students to both give and receive work, as well as to absorb large amounts of information about anatomy and Rolfing theory in a period of about 10 weeks. It's not uncommon as a Unit II student to feel pressured and at your "edges" as a combination of the learning challenges and receiving at least two Rolfing sessions a week. One day the student working on me was doing her pre-session visual analysis, with an instructor observing. She was frustrated with her work and said something like "I fixed the arches in Anne's feet last session and now I don't see the change anymore, what happened?!!" While I intellectually understood her frustration with her learning curve and felt for her, my body had an entirely different reaction: It felt like it locked down and said "well then, screw you, I'm not going to change just to make you happy."

This is why one of the things we learn in Rolfing training is to language change in a way that is supportive. Here's an example: As a practitioner, I could say "Your shoulders are up in your ears, you've got to learn to let them go," which implies complaint, judgement, and an expectation that you change for me. Alternatively, I could say "How would it feel if your shoulders could relax back and settle here?" (using my hands on the mid-back to give a sensory cue). This is language that is meant to evoke, to help the body feel and consider an alternative that might be more comfortable. It's also language that invites the body to participate, rather than to put up resistance and deflector shields in the face of demands for it to change.

Whatever our pain or posture issues are, these bodies we move through life in are a miracle of interconnected functioning. They work so hard for us in the face of our criticisms and judgments ("sit up straight," "you're too fat," "you used to be in shape," "you're looking old"....) Any time you find yourself wishing something were different about your body, I encourage you to take steps toward that betterment, and at the same time to appreciate all that your body does for you despite whatever limitations it may have. That viewpoint makes it easier to enlist all of you in the change you seek.

June 06, 2009

Here's a nice Rolfing® article that discusses the use of Rolfing for pain relief after an auto accident. The article features my colleague Emily Gordon in Maryland, and talks about how three sessions of Rolfing are giving one of her clients relief from the constant pain he has been in since an auto accident some six years ago. I have also found this to be true with the many clients coming in to see me for Rolfing on auto and workers' compensation claims in the dozen-plus years I've been in practice (first in Hawaii, now in Seattle). In most of the cases I've worked with, clients find that Rolfing® is what really gets them out of the woods, bringing relief that was not found through just chiropractic care, physical therapy, or massage – although these can be valuable components of a full treatment plan, as well as acupuncture.

When a client comes to my Rolfing practice after an auto accident, there are several things to consider. If the accident was recent, and the person is in significant pain, we have to see whether he responds best to direct Rolfing, or to indirect techniques that are very gentle. If the accident was particularly traumatic or shocking, or if the neck is highly guarded because of a whiplash, we may start with craniosacral work to drain some of the shock from the system.

I also want to know how the person was hit, and how he was positioned at the time, as that - plus a visual analysis - tells me how the force vectors that entered the body may have impacted the myofascial, cranial, and organ systems. For example, if you were rear-ended while you were the driver, stopped at a traffic signal, with your seatbelt on and your right foot jammed on the brake, and your head turned to the right to say something to the person in the passenger seat, I know immediately that there may be a chain of compression up the right leg affecting the foot/ankle/knee/hip, and a whiplash effect with a right rotation in the musculature of the neck and torso as your body was propelled forward into and around the seatbelt.

If a client has had many sessions of other treatment, including myofascial massage, it may be an indication that the cranial or visceral (organ) component of the accident was not addressed and will be the missing link. For example, whiplash can put strain around the suspensory ligaments of the pleura; in this case, even great myofascial work to the neck muscles will not bring a permanent fix until those ligaments are under less strain.

I'm passionate about helping people get out of suffering and back to their normal lives after auto and work accidents, and think that Rolfing® – combined with craniosacral and visceral work as needed – is the best form of manual therapy to deal with this intricate problem-solving. The silver lining to an auto accident is that insurance will usually fully cover the treatments if prescribed by a medical doctor or chiropractor. While some Rolfers™ will not bill your auto insurer or workers' compensation program directly, I have found that these agencies are usually easy to work with, and I am happy to do that so my clients have one less burden to deal with while they are recovering.

April 25, 2009

Pelvic pain is a challenging issue for many women - one that can be hard to speak about, and hard to find effective treatment for. It can involve pain in the pelvic musculature or genitals, or pain with intercourse. Flare-ups can cause discomfort with sitting and exercising as well.

I've worked with a small number of women with this condition and have found that multiple modalities are usually called for. I've gotten good results from Rolfing® techniques to balance the pelvic fascias and musculature, especially combined with nerve release techniques (another form of manual therapy). Sometimes visceral work to release strain patterns around the pelvic organs has helped, sometimes craniosacral balancing to the sacrum and SI joints. I usually get a sense of which techniques to start with through a postural assessment and good medical/injury history. For example, falls onto the tailbone can cause imbalances in musculature and fascia that travel through the pelvic floor.

Given that the matter is complex, and requires different approaches, one may need to see multiple practitioners. I also recommend osteopathic treatment, and physical therapy - particularly if one can find a PT specializing in this syndrome.

What is important to note is that manual therapy techniques can make a difference in reducing pain and improving quality of life.